Description: This application proposes to utilize Supplemental Security Income (SSI) and Medicaid claims data from 1989 to 1992 in six states to: (1) characterize patterns of care; (2) examine the association of case pattern with resource use and quality; (3) study effects of provider characteristics and supply; (4) study rural/urban effects and demographic characteristics, and (5) compare pediatric and non-pediatric subspecialists. A number of childhood chronic conditions will be analyzed to better understand referral patterns and their consequences. Several referral patterns will be explored, including primary care management, co-management, one-time subspecialty consultation, and subspecialty management. American Medical Association (AMA) data files will be linked to track care by specialty type and to compare, in addition to the usual and customary demographics, care provided by adult versus pediatric specialists. Dependent variables monitored will include utilization, costs, certain quality indicators (e.g., regular eye exams for diabetics), and some outcomes (e.g., urinary tract infections in patients with spina bifida).